Reflective skills of pharmacists in patient counselling
Keywords:
Pharmacists, level of critical reflection, reflectivity, learning processAbstract
Background: Both the work and the roles of community pharmacists have been changing rapidly over the last decades. Nowadays pharmacists are expected to develop and re-evaluate their expertise in order to succeed in an ever-changing professional culture contributing to the demands of society. One of the tasks that, has become essential in modern pharmacy practice is reflective communication about medicines with patients. The worldwide experiences of Pharmacists include problems in applying theoretical knowledge in a practice setting and particularly in patient counselling.
Aim: To describe the levels of reflective learning of 40 Finnish community pharmacists in the context of patient counselling and health education. Theories that are used as a framework for the analysis are based on patient counselling according to USP Medication Counselling Stages and Metzirow’s theoretical underpinning.
Method: The data for this study comprised of essays written by a convenience sample of 40 practicing pharmacists(M.Sc. Pharm. and B.Sc. Pharm) before starting the one-year patient counselling courses in 2000 (n=21) and 2001(n=19). The data were thematically content analysed. Results: The findings of the study identified only one pharmacist reached the level of critical consciousness. Altogether 22 pharmacists remained at the level of affective reflectivity (i.e. the novice level of competency) and 10 remained at the level consciousness (i.e. the beginner level of competency). These pharmacists belonging to these two groups needed continuing education in basic pharmacotherapy knowledge and communication skills. Apart from one pharmacist, they had poor understanding of the interactive role of a customer (concordance).
Conclusions: These results may indicate that the pharmacist should reach the level of critical reflection before (s)he can develop competency empowerment-based patient counselling. New teaching methods and evaluation tools applicable to basic education, continuing education and in-house training are needed to support reflective learning process in developing professional competencies, such as patient counselling skills.
References
Airaksinen, M., Ahonen, R., & Enlund, H. (1998). The “Questions To Ask About Your Medicies” Campaign—An evaluation of pharmacists and the public’s response. Medical Care,36,422 –427.
Apteekki potilaan parhaaksi, Tippa Project Middle-Stage Report2000-2001 (in Finnish with English summary) On the Internethttp//www.tippa.net. Accessed 06/2003
Benson, A., & Latter, S. (1998). Implementing health promoting nursing: The integration of interpersonal and health promotion. Journal of Advanced Nursing,27, 100–107.
Bereiter, C., & Scardamalia, M. (1993).Surpassing Ourselves. An inquiry into the nature and implications of expertise (Chicago,II, open Court).
Blenkinsopp, A., Panton, R., & Anderson, C. (2000).Health promotion for pharmacists, 2nd ed. Oxford: University Press.
Content analysis in qualitative research. http//www.metodix.com. Accessed from the Internet 02/2003.
De young, M. (1996). Reflections on guidelines and theories for pharmacist–patient interactions. Journal of Pharmacy Teaching,5, 59–81.
Entwistle, N., Entwistel, A., & Tait, H. (1993). Academic understanding and context to enhance it: A perspective from research on student learning. In T. M. Duffy, J. Lowyck, & D. H.Jonassen (Eds.), Designing Environments for Constructive Learning, Vol. 105 NATO Asi Series. Series F: Computer and Systems Sciences (pp. 331 –357).
Hargie, O., Morrow, N., & Woodman, C. (2000). Pharmacits’evaluation of key communication skills in practice. Patient Educational Counselling,39, 61–70.
Harre ́, R. (1979).Social Being. Oxford: Basil Blackwell.Hepler, C. D., & Strand, L. M. (1993). Opportunities and esponsibilities in pharmaceutical care. American Journal of Hospital Pharmacy,47, 533–543.
Jarvis, P. (1992). Reflective practice and nursing. Nursing Education,12, 174 –181.
Jonassen, D., Maynes, T., & McAleese, R. (1993). A manifesto for a constructive approach to uses of technology in higher education. In T. M. Duffy, J. Lowyck, & D. H.
Jonassen (Eds.),Designing Environments for Constructive Learning, Vol. 105 NATO AsiSeries. Series F: Computer and Systems Sciences (pp. 231–247).
Kansanaho, H., Pietila ̈, K., & Airaksinen, M. (2003a). Can a long-term continuing education course in patient counselling promote a change in the practice of Finnish community pharmacists? International Journal of Pharmacy Practice,11,153 –160.
Kansanaho, H., Puumalainen, I., Varunki, M., Ahonen, R.,Airaksinen, M., (2003b). Implementation of a professionally oriented business strategy in Finnish community pharmacies-Does a 4-year program make a change? Submitted PEC 2/2004.
Katajavuori, N., Valtonen, S., Pietila ̈, K., Pekkonen, O., Lindblom-Yla ̈nne, S., & Airaksinen, M. (2002). Myths behind patient counselling; a patient counselling study of non-prescription medicines in Finland. Journal of Social and AdministrativePharmacy,19(4), 129–136.
Katajavuori, N., Hirvonen, J., & Lindblom-Yla ̈nne, S. (2003). The Development of excellence in pharmaceutical knowledge–New curriculum for the B.Sc (Pharmacy) studies. Pharmacy education,3(3), 149–160.
Lonka, K., & Ahola, K. (1995). Activating instruction: How tofoster study and thinking skills in higher education. European Journal of Psychology of Education,10, 351–368.
Marinker, M. (1997). From compliance to concordance- achieving shared goals in medicine taking. London: Royal Pharmaceutical Society of Great Britain Merck Sharp and Dohme.
Marton, F., Dall’Alba, G., & Beaty, E. (1993). Conceptions of Learning. International Journal of Educational Research,19,277 –300.
Metzirow, J. (1991).Transformative dimensions of adult learning. San Francisco, CA: Jossey-Bass publishers.
Mezirow, J. (1981). A critical theory of adult learning and education. Adult Education,32(1), 3 –24
Pietila ̈, V. (1976). Sisallon erittely. Gaudeamus: Helsinki, (in Finnish.Content analysis).
Poskiparta, M. (1996). Terveysneuvonta, oppimaan oppimista.Videotallenteet hoitajien terveysneuvonnan ilmentajinaja vuorovaikutustaitojen kehittamismenetelmana . Doctoral dissertation, Studies in sport physical education and health 46Jyvaskyla , Jyvaskylan yliopistopaino, (in Finnish) (Nurses ‘self-assessment via videotaping to development
communication skills)University of Jyvaskyla .
Puumalainen, I., Kansanaho, H., Varunki, M., Ahonen, R., & Airaksinen, M. (2003). Usefulness of the USP Medication Counselling Behaviour Guidelines in Improving the Patient Counselling Practices from Community Pharmacies. International Journal of Pharmacy Practice submitted 9/2003.
Savela, E. (2003). Professional competence in community pharmacies- Continuing education among Finnish pharmacists applying the Norm theory as a theoretical framework. Doctoral dissertation, Pharmaceutical Sciences62 Kuopio, University of Kuopio, Kuopio University Publications A.
Schon, D. (1987).Educating the reflective practitioner: Toward a new design for Teaching and Learning in Problems. San Franciso: JosseyBass Publisers.
Sihvo, S., & Hemminki, E. (1999). Self-medication and health habits in the management of upper gastrointestinal symptoms. Patient Education and Counselling,37, 55–63.
Sihvo, S., Ahonen, R., Mikander, H., & Hemminki, E. (2000). Self-medication with vaginal antifungal drugs: Physicians experiences and women’s utilization patterns. Family Practice,17(2),145 –149.
Smyth, J. (1992). Teacher work and the politics of reflection. American Educational Research,2, 267– 300.
Szasz, T., & Hollander, M. (1956). A contribution to the philosophy of medicine. AMA Archives of Internal Medicine,97, 585–592.
Tiuraniemi, J. (2002). Reflektiivisyys asiantuntijatyo ssa. TeoksessaTaitavan toiminnan psykologia. In P. Niemi, & E. ja Keskinen(Eds.),Turun yliopiston psykologian laitoksen julkaisuja. Turku:Yliopistopaino, Reflectivity in professional competence(In Finnish).
Tomm, K. (1988). Interventine interviewing: Part III intending toask lineal, circular, strategig or reflective questions?FamilyProcess,27, 1 –15.
Tynjala, P., (1996). Writing as a learning tool in university studies, a poster presented at the European Conference on Educational Research, 25–28 September Seville, Spain.
Tynjala , P., Nuutinen, A., Etelapelto, A., Kirjonen, J., & Remes, P.(1997). The acquisition of professional expertise—a challenge for educational research. Scandinavian Journal of EducationalResearch,41, 475 –494.
United States of Pharmacopeia. On the Internet: http://www.usp.org Accessed 06/2002
Van Manen, M. (1977). Linking ways of knowing with ways of being practical. Curriculum Inquiry,6, 205–228.
Vermut, J. (1995). Process-oriented instruction in learning and thinking strategies. European Journal of Psychology of Education,10, 325–349.
Volet, S., McGill, T., & Pears, H. (1995). Implementing process-based instruction in regular university teaching: Conceptual,methodological and practical issues. European Journal of Psychology of Education,10, 385–400.
WHO/Regional Office of Europe. (1999). Health 21—Health for all in the 21st century. In The Health for all Policy Framework for the WHO European Region. European “Health for All” Series no.6(p. Copenhagen). Copenhagen: Regional office of Europe
